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In the category of larger states, Jharkhand turned out to be the biggest gainer in terms of its annual increment performance, followed by Jammu and Kashmir. Rajasthan, Bihar and Odisha also performed poorly.

Among small states, Mizoram ranks first, followed by Manipur and Goa.

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The NITI Aayogsaid it is a weighted composite index based on indicators in three domains: health outcomes (70 per cent weightage), governance and information (12 per cent), and key inputs and processes (18 per cent).

The Index ranked States and UTs in three categories namely - Larger States, Smaller States, and Union Territories (UTs) - to ensure comparison among similar entities.

Among the union territories, Lakshadweep showed both the best overall performance, as well as the highest annual incremental performance.

In a report released on Friday by Niti Aayog, Maharashtra ranked behind its smaller counterparts like Kerala, Punjab, Tamil Nadu, Gujarat and Himachal Pradesh in various health parameters.

While releasing the report, NITI Aayog CEO Amitabh Kant said it would serve as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes.

"In the reference year (2015-16) among the larger states, the index scope for overall performances ranged widely between 33.69 in Uttar Pradesh to 76.55 in Kerala", it said. "We want to encourage the good performers and name and shame those who don't".

The next health report on states performance will be released in June this year and district hospitals too would be ranked, he said. The performance of states was judged on health outcomes from base year (2014-15) to reference year (2015-16) on indicators such as neonatal mortality rate, under-five mortality rate, full immunisation coverage, institutional deliveries and people living with HIV on anti-retroviral therapy. Manipur is also on the top of the list of annual increment performance.

The Aayog identified some common challenges across states such as vacancies, establishment of functional district Cardiac Care Units, quality accreditation of public health facilities and institutionalisation of Human Resources Management Information System.

Further, Maharashtra has recorded substantial drop (10 or more points) in sex Ratio at Birth indicator which reflects the extent to which there is a reduction in the number of girl children born by sex-selective abortions.

The report also noted that rich learnings have emerged in the first year and these will guide in refining the index for the coming year and also address some of the limitations. This Index is expected to nudge States towards further achieving a rapid transformation of their health systems and population health outcomes.

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